Healthcare Provider Details

I. General information

NPI: 1457815268
Provider Name (Legal Business Name): KELSEY THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY SONDGEROTH

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 S HAMPTON DR
BETTENDORF IA
52722-2647
US

IV. Provider business mailing address

6410 APPOMATTOX RD
DAVENPORT IA
52806-1942
US

V. Phone/Fax

Practice location:
  • Phone: 563-484-0434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number083626
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: